title: The impact of the 21-gene Recurrence Score assay on clinical decision-making in node-positive (up to 3 positive nodes) estrogen receptor-positive breast cancer patients.
abstract: Oncotype DX testing is reimbursed in Israel for node-negative and node-positive (N1+; up to 3 positive nodes including micrometastases), estrogen receptor positive (ER+), breast cancer patients. This retrospective study evaluated the impact of Oncotype DX testing on treatment decisions in N1+/ER+ breast cancer patients. To this end, we compared treatments for all N+ patients for whom testing had been ordered with treatments for patients with similar characteristics where the test had not been available. The retrospective analysis included 951 patients (282 Oncotype DX, 669 controls), all of whom received endocrine therapy with or without chemotherapy. In Oncotype DX patients, 7.1, 37.0, and 100 % of those with low, intermediate, and high Recurrence Score results (Oncotype DX summary score) received chemotherapy, respectively (P < 0.0001, all comparisons). Chemotherapy use was lower in Oncotype DX patients versus controls (24.5 vs. 70.1 %). In a multivariate logistic regression analysis in which the probability of receiving chemotherapy was modeled as a function of Oncotype DX testing, age, tumor size, tumor grade, nodal status, and the interactions between Oncotype DX testing and the other covariates, Oncotype DX testing was associated with significantly lower odds of receiving chemotherapy (odds ratio 0.16; 95 % CI 0.11-0.24; P < 0.0001). In summary, our findings suggest that Oncotype DX testing has a significant impact on reducing chemotherapy use in N1+/ER+ breast cancer patients in Israel.
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva/Sackler Faculty of Medicine, 39 Jabotinski St., Petah Tikva, Israel. stemmer@post.tau.ac.il
authors.forename: Salomon M
authors.initials: SM
authors.lastname: Stemmer
authors.forename: Shmuel H
authors.initials: SH
authors.lastname: Klang
authors.forename: Noa
authors.initials: N
authors.lastname: Ben-Baruch
authors.forename: David B
authors.initials: DB
authors.lastname: Geffen
authors.forename: Mariana
authors.initials: M
authors.lastname: Steiner
authors.forename: Lior
authors.initials: L
authors.lastname: Soussan-Gutman
authors.forename: Shahar
authors.initials: S
authors.lastname: Merling
authors.forename: Christer
authors.initials: C
authors.lastname: Svedman
authors.forename: Shulamith
authors.initials: S
authors.lastname: Rizel
authors.forename: Nicky
authors.initials: N
authors.lastname: Lieberman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000378:metabolism / Q000473:pathology*; D003661:Decision Support Techniques; D005260:Female; D020869:Gene Expression Profiling / Q000379:methods*; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D012189:Retrospective Studies
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; C508053:ERBB2 protein, human